Neurosarcoidosis presenting as a cerebellar mass

CASE REPORT: A 74-year-old farmer presented with worsening headaches, gait unsteadiness, and writing difficulties. On examination, he had a tendency to fall to the right and right-sided dysmetria and dysdiadochokinesis. Magnetic resonance imaging initially showed abnormalities in the right cerebellar hemisphere, suggestive of subacute infarct or infiltrating malignancy. Suboccipital craniotomy and biopsy revealed noncaseating granulomas suggestive of sarcoidosis. He was initially treated with steroids and later switched to Infliximab. On follow-up 5 months later, symptoms and imaging had improved. DISCUSSION: Sarcoidosis affects the central nervous system in about 5% of patients. It usually manifests with cranial nerve palsies. It may rarely mimic a tumor as in this patient. Despite the dearth of controlled studies addressing neurosarcoidosis treatment, excellent responses to corticosteroids have been documented. Infliximab has been used as a steroid-sparing agent in neurosarcoidosis. We present this case of neurosarcoidosis presenting as a cerebellar mass to increase awareness of this condition.